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We read with great interest the paper by Taruya et al. (1) in a previous issue of the Journal. The authors should be congratulated for their detailed work. Utilizing as an imaging modality the light-based optical coherence tomography (OCT), they have shown that vasa vasorum (VV) and intraplaque neovascularization structure volumes differ between various plaque characteristics. In particular, the VV volume is positively correlated with fibrous plaque volume, whereas specific 3-dimensional structures of intraplaque neovessels are associated with plaque vulnerability.

Although we think that this work represents a significant contribution to the field of VV, we have some comments regarding the findings and their interpretation.

On the basis of our findings, we believe that images of VV and intraplaque neovessels obtained during the short time interval of 2 to 3 s (pull back imaging with OCT) represent only a part of the total VV and intraplaque neovessel existing network (external and internal) that nourishes the atherosclerotic plaque (2). Indeed, we have shown in an almost operator-independent quantitative analysis of contrast-enhanced intravascular ultrasound that maximal perfusion of the coronary atherosclerotic plaque through the existing VV network occurs at 20 s post-intracoronary contrast injection (2). Therefore, the obtained images and calculated volumes of VV and intraplaque neovessels may not reflect the total volume that perfuses the plaque, and as a result, correlations between study volumes of VV and atherosclerotic plaques may not be ideal. Furthermore, apart from the increased intracoronary pressure produced by continuous contrast infusion during OCT imaging on neovessel volume, rheological intraluminal conditions can be instantly altered by hemodynamics and heart movement, leading to constant fluctuation of volume. Additionally, the flashed x-ray contrast may influence the image that is received and analyzed further off-line, by interacting within the studied microvessels, as the analyzed frame is captured simultaneously with flashing.

The findings of Taruya et al. (1) add significant information to previously published data indicating the key role of neovascularization within the atherosclerotic plaque (3). Doubtless, VV neovascularization imaging and assessment, either with OCT or contrast-enhanced intravascular ultrasound, can be established as a valuable tool for vulnerable plaque detection and its therapeutic regression.

Footnotes

Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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